Maternity Flashcards
1
Q
How do chronic illnesses change during pregnancy?
A
They are exacerbated
2
Q
Most medications for chronic diseases are…
A
teratogenic
3
Q
How do chronic diseases affect fetal growth and why?
A
IUGR d/t decreased placental perfusion
4
Q
How may medication doses need to be adjusted during pregnancy?
A
Increased
5
Q
How much does a woman’s blood volume increase during pregnancy? When does this peak?
A
30-50%
28-32 weeks
6
Q
What weeks are a CV problem most likely to present?
A
28-32
7
Q
Is warfarin teratogenic?
Digoxin?
Heparin
A
Yes
No, no
8
Q
Who must be involved when a CVD is present during pregnancy?
A
cardiologist, OB
9
Q
What kind of findings indicate a CV problem
A
Edema beyond feet
SOB not readily relieved
Increased # of pillows at night
Chest pain
10
Q
What intervention during labor for a CVD?
A
No pushing with contractions, epidural anesthetic
11
Q
What post partum interventions for one with CVD
A
anticoagulants, digoxin, TEDS, abs, stool softener
12
Q
2 things to inform mom of when she is pregnant with a pre existing illness
A
promote rest (2/day, left lateral) promote healthy nutrition (prenatal vitamins, iron supplements)
13
Q
What are the 3 goals when a pre existing illness is at play
A
grow the baby
increase placental perfusion
increase mom’s energy
14
Q
What may the baby be born with/how when a CVD is present
A
low birth weight
preterm labour
CS may be necessary
15
Q
what kinds of anticoagulants do not cross placenta?
A
LMWH (dalteparin)
16
Q
RSHF in pregnancy symptoms
A
hepatomegaly causing dyspnea
peripheral edema
17
Q
How does anemia affect birth weight?
A
Decreases d/t decreased placental perfusion
18
Q
What level of Hgb is concerning and what to do?
A
<110
ask mom if she has symptoms and if she knows how to increase the value
19
Q
How much does Fe a healthy pregnant woman need a day? How much does an anemic woman?
A
27 mg/day
120-400 mg/day
20
Q
Common side effect of Fe supplements? How to combat them?
A
Increase fibre and stool softeners
21
Q
How to increase Fe absorption
A
Vit C, OJ
22
Q
What lifestyle changes must an anemic pregnant woman make?
A
Rest periods, limiting exercise/work
23
Q
What is another name for folic acid deficient anemia?
A
megloblastic anemia
24
Q
Why is folic acid so necessary during pregnancy?
A
Form RBCs
Prevents neural tube/abdominal wall defects in the fetus
25
How much folic acid should a pregnant woman have/day
400 mcg/day
26
In a sudden pregnancy complications, how often are VS done? What other assessments?
q 5-15 mins
| STAT BW, EFM, output
27
What is the presenting symptom of a SA?
vaginal bleeding
28
Causes of SA?
```
abnormal development
implantation abnormalities
alcohol
UTIs
systemic infections
```
29
What is a complication of SA? How is it avoided?
Infection r/t retained POC, Abx/D&C
30
Which weeks is bleeding serious for a SA?
6-12
31
Bleeding during pregnancy is
always a deviation from normal
| always potentially serious as it may indicate a SA
32
When can bleeding due to SA be life threatening?
after 12 weeks
33
What is the most common cause of painless bleeding in the third trimester?
Placenta previa
34
What is the greatest concern in placenta previa?
Hemorrhage
35
When is a CS necessary during placenta previa?
>30%
36
Which pregnancy complication are PV exams prohibited?
Placenta previa
37
Which medication is given during placenta previa and why?
Betamethasone to mature baby's lungs if preterm delivery is to happen
38
What is abruptio placentae?
Premature separation of the placenta = bleeding
39
What kind of pain during abruptio placentae? Is there always pain? Why/why not
sharp stabbing pain at fundus
| no if concealed
40
What is the most common cause of perinatal death?
Abruptio placentae
41
What 3 risks abruptio placentae?
DIC
amniotic fluid embolus
hemorrhage
42
What 2 interventions are necessary during abruptio placentae?
emergency delivery
| check for neonatal hypoxia at birth
43
What is preterm labor?
Labor occurring before end of week 37
44
Causes of PTL?
DEHYDRATION
UTI
interpartner violence/abuse
Low SE status
45
What indicates actual labor vs braxton hicks?
>4 contractions in 20 minutes
46
5 interventions for PTL
Bed rest
IV fluids
terbutaline (tocolytic)
betamethasone
47
What is a major risk in PROM
infection, cord prolapse
48
What is the fluid in PROM tested for?
Ferning
| Nitrazine paper
49
How often are vitals taken in PROM
q4 h for signs of infection
50
3 interventions PROM
IV Abx, bedrest, betamethasone
51
5 interventions cord prolapse
```
do an internal exam
take fetal HR
keep mom LL/butt up in air
sterile glove, push baby's head off cord
cord soaked in saline gauze if external
```
52
What causes gestational hypertension?
VASOSPASM
53
What in mm hg is gestational HTN?
30 above baseline
54
3 cardinal signs of preeclampsia?
140/90, proteinuria, edema (up legs, eyes, sacrum)
55
Assessments during gestational HTN?
```
headache
visual changes
epigastric pain
hyperreflexia
urine protein
creatinine
LFTs
clonus
daily weight
```
56
Tx of gestational HTN
anti platelet
bed rest
MgSO4
labetolol
57
What sign indicates an impending seizure?
signs of clonus
58
Why is MgSO4 given during preeclampsia?
to prevent seizures
59
3 features of HELLP
hemolysis, elevated LFTs, low platelets
60
What is the tx of HELLP
delivering baby, transfuse fresh frozen plasma/platelets
61
What is a precursor to HELLP?
Preeclampsia
62
Important assessments/lab values during a high risk pregnancy?
EFM
platelets (worried about DIC)
D-dimer (has mom's blood mixed with baby's)
Hgb/Hct
63
What indicates true anemia?
Hit <33%
64
How will Hct/Hgb change during pregnancy?
Decreased d/t hemodilution
65
What is the tx for GERD
PPI (esomeprazone, rat B)
| wear loose clothing, sleep with head elevated
66
What kinds of hepatitis are/arent transmitted to fetus?
A = no
| B & C - yes
67
Tx for hepatitis during pregnancy
Bed rest, high calorie diet, CS
68
Is a mom with hepatitis able to breastfeed?
Yes
69
What interventions once a baby is born to a mom with hepatitis?
Wash infant well
hepatitis B IG
1st dose hepatitis B vaccine administered
70
Why does cholecystitis happen during pregnancy?
hypercholesterolemia happens early in pregnancy leading to formation of gallstones
71
Tx cholesystisis?
```
Lower fat intake
Rest GI tract temporarily
IV fluids
Analgesics
Laproscopic sx to remove stones if needed
```
72
What mental illness meds may be teratogenic?
lithium
| SSRIs
73
Why does antiphospholipid antibody syndrome cause a woman to miscarry?
Tx?
Risks postpartum?
coagulation in placental veins = growth blocked = MCs/HTN
prevention = ASA 81 mg, subcut heparin, prednisone
DVT
74
Where are most ectopic pregnancies implanted?
S/S?
Why is hemorrhage a concern?
What medication to treat?
fallopian tube
bleeding, sharp abd. pain
ruptured BVs, intraretroperitoneal bleeding
methotrexate
75
What is hydatiform mole?
abnormal proliferation of trophoblasts (associated with choriocarcinoma) malignant
76
What is cervical cerclage?
Sutures to strengthen cervix and prevent it from dilating until end of pregnancy in the case of cervical insufficiency
77
Why are multiple gestations a concern?
More susceptible to gestational HTN, hydramnios, placenta previa, PTL, anemia, post partum bleeding, low birth weights
78
What is the normal amount of amniotic fluid for a woman to have? How much does she have with hydramnios?
500-1000 mL @ term
| >2000 mL
79
What causes hydramnios?
difficulty of fetus to swallow/absorb, excessive urine production
80
What procedure will a woman with hydramnios receive?
Amniocentesis
81
What are the causes of oligohydramnios?
Bladder/renal disorder of fetus, severe IUGR
82
What should a nurse assess for in a neonate who had oligohydramnios?
Kidney disease and compromised lung development
83
What dangers to the fetus in a post term pregnancy?
Meconium aspiration, macrosomia
84
For the pregnant teen, what developmental task may be interrupted (Erikson) and how to help guide that?
Identity vs Role Confusion
Allow for independence from parents on health decisions
85
What approach should be taken when interviewing a teen on their HH?
Gain detailed info by digging deeper, as teens are very private/vague
86
7 complications associated with teen pregnancy?
```
imbalanced nutrition
PPH
cephalopelvic disproportion
gestational HTN
iron deficient anemia
preterm labor
low birth weight
```
87
Chromosomal risks associated with advanced maternal age and what test is done?
Down Syndrome
| alpha fetal protein test
88
Complications associated with advanced maternal age
PPH
gestational HTN
FTP
SA/Stillbirth/PTL
89
Cocaine's effect on the baby?
abruptio placentae, PTL, death, low FHR variability, intracranial hemorrhage, abstinence syndrome
90
What are the symptoms of abstinence syndrome?
tremors, irritability, rigidity
91
What will the baby addicted to amphetamines present like?
Jittery, feed poorly, growth restriction
92
Is breastmilk affected by amphetamines?
Yes, the drug is excreted into breast milk so no breast feeding
93
How does phencyclidine (PCP) affect fetuses?
Drug concentrates in fetal cells and is potentially injuries
94
How will a baby addicted to narcotics present?
opiate dependence, abstinence symptoms, low birth weight, meconium aspiration, able to cope with bilirubin d/t increased liver development
95
What are the abstinence symptoms of narcotic withdrawal?
N/V/D, abd pain, shivering, insomnia, jerking movements
96
How do inhalants effect the body? the fetus?
Respiratory and cardiac irregularities = fetal hypoxia
97
What effect does alcohol abuse have on the baby?
Fetal alcohol spectrum disorder
98
Risk factors for uterine rupture (5)
CPD, prolonged labor, abnormal presentation, multiple gestation, oxytocin too early
99
S/S uterine rupture
severe pain during contraction, 2 swellings on abdomen, hemorrhage, hypovolemic shock
100
Tx uterine rupture
fluid replacement, IV oxytocin
101
2 events that cause uterine inversion?
traction applied to the cord, pressure applied to funds when uterus not contracted
102
3 signs of uterine inversion?
hemorrhage from vagina, protrusion from vagina, funds not palpable
103
Interventions uterine inversion (6)
DC oxytocin, IV fluid, O2 via mask, VS, tocolytic drug IV, Abx
104
Presentation of a women with an amniotic fluid embolism?
sharp chest pain, inability to breathe, pale, cyanotic, LOC
105
What is amniotic fluid embolism associated with?
Induction of labor, multiple pregnancies, hydramnios
106
Can amniotic fluid embolism be prevented? Why/why not?
No because it cannot be predicted
107
placenta succenturiata
1+ accessory lobes to placenta
no fetal abnormalities
risk for hemorrhage
108
placenta circumvallata
fetal side of placenta is covered with chorion
109
battledore placenta
cord inserted marginally rather than centrally
110
velamentous insertion of the cord
cord does not enter placenta directly, but rather separates into small vessles
found in multis
associated with fetal abnormalities
111
vasa previa
umbilical vessels cross os, therefore deliver before baby
112
placenta accreta
deep attachment of placenta to myometrium that placenta cannot peel off and deliver
hysterectomy or methotrexate may be indicated
113
what are the two umbilical cord anomalies?
two vessel cord
| unusual cord length
114
What are the normal vessels in the umbilical cord?
1 vein, 2 arteries (3 vessels)
115
When there is a two vessel cord, what abnormalities are associated? What nursing indications at birth must be done for all babies therefore?
Kidney & cardiac abnormalities
| Inspection of the cord at birth
116
What risks does a ++ short cord impose?
Premature separation of the placenta
117
What risks does a ++ long cord carry?
Getting twisted/knotted, wrapped around fetus' neck
118
What hepatitis is most commonly associated with substance abuse?
Hep B
119
Why do illicit substances cause fetal effects? (in terms of the drug's composition?)
small molecular weight
120
When labor deviates from normal, what is the nurse to do?
Consult physician (OB/GP), communicate and act early
121
1:1 nursing care during...
Labor
122
What are the 2 phases of labor?
Latent & Active
123
4 stages of labor/birth?
1 - laboring/dilation
2 - pushing, descent, delivery
3 - delivery of placenta
4 - hemostasis
124
How long after the placenta delivers is 1:1 nursing needed?
2 hours
125
How long can the latent phase of labor last for?
2 days
126
Which phase of labor features irregular contractions?
Latent
127
When is the latent phase over?
When a regular contraction pattern is established and the cervix is 3-4 cm dilated
128
What phase of labor are contractions strong and regular?
Active
129
What are the contractions like in duration/frequency in the active stage of labor?
q2-3 mins, last 60 seconds each
130
How dilated is a woman in active labor?
3-10 cm
131
What causes dystocia?
Problems with any of the 4 P's
132
What does dystocia increase the risks for? (5)
```
infection
hemorrhage
uterine rupture
fistula development
Infant mortality r/t inadequate oxygenation
```
133
At what mmHg does the uterine force cause potential damage to the fetus/mom?
>50 mmHg
134
How often should a labouring woman urinate?
q2 h
135
What can a full bladder lead to after birth?
hemorrhage
136
How does constipation impact labor?
Can prevent the latent phase from progressing
137
A woman with ketones in her urine during labor needs...
Dextrose IV/candy as glucose is low
138
How do narcotics effect labor?
Can stop it
139
Most important factor during labor for mom to continue healthy labouring?
*** HYDRATION ***
140
What are normal contractions like?
3-4 in 10 minutes
| Last 60 seconds with a 60 second resting tone
141
What length of contractions can cause fetal hypoxia?
>60 seconds
142
How should multips/primips dilate?
after 3-4 cm dilation:
M = 1 cm/hr
P = 1-1.5 cm/hr
143
When is oxytocin given during labor?
When dilation is not at normal rate (too slow) , hypotonic contractions, uncoordinated contraction
144
What is the risk of rapid dilation/hypertonic contractions?
Hypoxic infant
| Hemorrhage
145
What is the risk of precipitate labor (rapidly progressing labor)
Abruptio placentae
146
If labor is taking too long (hypotonic/slow dilation) what is the risk and what is the tx?
Infection & hemorrhage
| Oxytocin drip
147
What 2 kinds of babies often present for the mom with CPD
gestational diabetes (baby too large for pelvis) or overdue babies (plates in head start to fuse)
148
What is the risk of CPD on the uterus?
Uterine rupture
149
What is a pathological contraction ring and what is done if palpated?
palatable ring across abdomen across umbilicus, get OB involved, C/S indicated
150
What are 4 things the nurse should anticipate during a complicated labor?
Hemorhage
Exhaustion
Fetal distress
Infection
151
Is a transverse (shoulder) lie deliverable?
No
152
What positions/lies are deliverable
Longditudinal (cephalic, breech)
153
What variation of breech is unstable and why?
incomplete breech
| d/t risk for prolapse of cord
154
What variations of breech are deliverable?
Frank, complete
155
What are we worried about with breech babies?
CPD
156
What presentation will give woman ++ back pain ("back labor")
Occiput posterior
157
What is the best presentation
occiput anterior
158
What fetal problem is associated with shoulder dystocia?
Macrosomia
159
What is intervention acronym for shoulder dystocia?
HELPER
```
H = call for help
E = query episiotomy
L = legs into mcroberts
P = pressure
E = enter (physician breaks clavicle)
R = rotate (mom onto hands/knees)
```
160
What is shoulder dystocia?
Head is born but shoulder is stuck
161
How often is auscultation done during the first and second stages of labor?
Q15 for first
| Q5 for second (pushing)
162
How much variability is good for EFM?
15-20 bpm
163
How much/many accelerations is good in EFM?
>15 bpm above baseline for >15 seconds
164
What do early decelerations indicate?
head compression
165
What do late decelerations indicate?
fetal hypoxia
166
What causes variable decelerations in EFM?
cord compression
167
In EFM, what findings are worrisome?
Late decelerations and a loss of variability
168
What are indications for a forceps birth? 3
late decelerations
failure to progress
mom fatigued and not able to push
169
What are the 2 risks associated with a forceps birth?
Cranial nerve damage
Hematoma
Bladder damage for mom
170
What are the indications for a vacuum extraction?
Close to delivery and mom can push
| Baby is not preterm
171
What are the associated risks with a vacuum extraction?
subdural hematoma
| neurological decline
172
Instrumentation does what for mortality rates?
Decreases
173
What length of time of pushing warrants consults and investigation?
Over 2 hours
174
What factors predispose women to DVTs
increased fibrinogen
vessel dilation
estrogen
175
Which women are at risk for DVTs
inactive in labor/postpartum
Pre existing obesity/varicose veins
Post partal infection
Cigarette smoking
176
Prevention of mastitis
Good latch and unlatch baby before removal from breast
Good HH
Expose nipples to air
vit E ointment
177
What organisms are associated with nosocomial mastitis?
Staph aureus, candidiasis
178
Assessment findings with mastitis
breast pain/swelling unilaterally
fever
scant breast milk
179
Tx for UTIs
amoxicillin/ampicillin
180
Which abx for cutis is contraindicated and why?
sulfa drugs, as they cause neonatal jaundice in BF babies
181
Which babies are at risk for RDS
preterm, macrocosmic, CS babies
182
When does surfactant usually form?
34 weeks gestation
183
SS RDS
low temp, nasal glaring, tachypnea (>60)
184
Risk of oxygen administration in neonates
retinopathy of prematurity
185
Cause of TTN
retained lung fluid not allowing proper O2 exchange
186
What is the normal resp rate for newborns? What is it in TTN?
30-60
| 80-120
187
Which babies are at risk for TTN
CS, mom has had lots of fluid in labor, preterm babies
188
When should TTN resolve
72 hours of life
189
What causes MAS
Hypoxia leading to vagal stimulation. This relaxes the anal sphincter and the baby mec's in the AF. The baby then aspirates the mec
190
Why is MAS a concern?
aspiration of meconium leads to respiratory distress, secondary infection = pneumonia
191
What are the S/S of MAS
hypoxemia, tachycardia, retraction, low Apgar, acidosis
192
What causes hemolytic disease of the newborn?
ABO incompatibility
| mom is Rh neg and baby is Rh +
193
What is hydrops fetalis?
Severe edema in the fetus (third spacing)
194
Why are high bilirubin levels dangerous?
can cause brain damage
195
How do successful feeding and phototherapy help treat hyperbilirubinemia?
Early feeding allows for elimination of bowels and therefore bilirubin
Light triggers the liver to process bilirubin for excretion
196
What are the normal TsB levels? When do those levels become dangerous?
0-3 mg/100 mL
| >20 mg/dL
197
why does hemorrhagic disease of the newborn happen?
Deficiency of vitamin K
198
What medication is given to prevent hemorrhagic disease of the newborn?
Vit K IM
199
What is NEC?
Bowel develops necrotic patches leading to impeded digestion. Can cause ileus, perforation, and peritonisis. D/t anoxia to bowel (breathing difficulty)
200
What causes retinopathy of prematurity?
Vasocontriction of immature retinal BVs
201
What does dystocia put the mom at risk for?(3)
PPH
Infection
PPD
202
How often is the funds assessed for postpartum and how long?
q 5-15 mins for the first 4 hours
203
How should the fundus move in regards to each postpartum daY?
Should be 1 finger breadth below umbilicus per day (day 0 = at umbilicus)
204
How is the fundus assessed?
With who hands
205
If the fundus is above where is should be what does the nurse do? What to do if this doesn't help?
Fundal massage to expel blood to prevent PPH
Call doc for order for oxytocin
206
If the fundus is found to the side, what does this mean, how can it be prevented, and what can it cause?What is the primary intervention?
bladder is full
get mom to void q2h
PPH
PUT IN A CATHETER!!!
207
The first day, the loch should saturate pads completely. T/F?
FALSE
208
How often should we be changing pads?
q3h
209
What colour should loch rub be?
Dark red
210
What does the assessment of the post portal woman always start with?
FUNDUS/LOCHIA
| then VS
211
When do most PPHs happen?
First 24 hours. Mostly within the first 4 hours
212
What causes late PPH
POC
213
What causes most PPH?
UTERINE ANTONY
214
If you suspect a PPH, what are your interventions in order?
```
Fundal massage
Call for help, call Dr
VS
Lower HOB
IV NS/LR (16-18 g)
Administer oxytocin as ordered
Catheter/void
```
215
What are the 4 PPH drugs used in what order?
Oxytocin
Misoprostil
Ergometrine
Hemabate
OMEH
216
What does misoprostil do?
Rectal tablet of prostaglandin derivative that causes uterus to tighten
217
What does ergometrine do and how is it given
Injection
similar to oxytocin but different mechanism
218
How does hemabate work? Side effects?
Smooth muscle contraction. Will have diarrhea/nausea
219
What is the LAST LAST resort in a PPH?
Hysterectomy
220
What 3 interventions will help cure a PPH most of the time?
Fundal massage
catheterization
oxytocin
221
How can a full bladder effect the uterus?
Can cause uterine antony and therefore PPH
222
How will a septic person's temperature present?
Fluctuate
223
How high will a woman with a PPI's WBCs be
18-20
224
What are the differences between lactogenesis symptoms and infection symptoms?
foul smelling lochia
High fever (low for lacto)
increase in bleeding few days postpartum
225
What are the 3 main focuses in the newborn nursing care?
Respirations
Extrauterine circulation
Temperature (thermoregulation)
226
If a baby is exposed to GBS what is the baby at risk for? How is this prevented?
Meningitis
| Abx during labor
227
TORCH infections?
```
Toxoplasmosis
Other (chicken pox/syphilis)
Rubella
Cytomeglaovirus
Herpes Simplex
```
228
If your rubella titre is low, what will happen?
You will be vaccinated when you are discharged from MB. Cannot give while pregnant as this vaccine can cause deafness and mental retardation in babies
229
When are apgar scores taken?
1, 5 and 10 minutes
230
What makes up the apgar score?
HR, Tone, Reflex irritability, color, respiratory effort
231
1 minute apgar.. what score indicates the baby is having a hard time adjusting? what score indicates the baby needs to be in the NICU?
<5
| <2-3
232
5 minute apgar = what score does the baby need to have 1:1 NICU nursing?
<7
233
Which babies will be more mucousy?
CS babies, babies born in precipitate labor
234
What will a baby who's mom had gestational diabetes BG be
low
235
Healthy babies need what interventions at birth?
Rubbed dry
| Kept warm
236
What 3 valves close in the fetal circulation?
ductus arteriosus
foramen ovale
ductus venosus
237
what do the ductus arterioles and foramen ovale do?
shunt blood to the lungs
238
What causes the FA/DA to stay/come back open?
cold stress/hypoglycemia
239
What will result from the FA/DA not closing?
acidosis, respiratory distress/failure as it is a return to fetal circulation
240
What timeframe is the most important for keeping the baby warm and the BG stable? Why?
First 18 hours of life
| to ensure the FA//DA close
241
What does surfactant do?
Reduces surface tension
242
If the surfactant ratio is not right (premature?) what will happen?
Weak/underdeveloped lung musculature and lungs will not be able to expand
243
What drug changes the surfactant ration to be more appropriate (like a term baby's?)
betamethasone
244
What kind of ventilation is given to babies that are premature?
CPAP (expands alveoli)
245
What factors lead to respiratory distress in preterm infants?
Decreased surfactant/lung maturity
Cold stress/acidosis
No brown fat
246
What 4 ways is heat lost?
Convection
Radiation
Conduction
Evaporation
247
what amount of blood loss is significant in a newborn?
15 mL
248
What can macrosomia cause in the newborn?
Respiratory distress
249
What do low BS contribute to?
Acidosis.. impedes then on respiratory function
250
How are macrocosmic babe supported?
Freq BG
Supplemental feeds
IV
O2
